3: Hematology | Leukocytes: Laboratory Determinations Questions 247 Which substrate is used for the detection of specific esterase? OSI’ a acetate b chloroacetate € pararosanilin acetate 4 phenylene diacetate 248 A useful chemical test for the diagnosis of hairy cell leukemia is the: OSM a peroxidase test b Sudan black test € periodic acid-Schiff test 4 tartrate-resistant acid phosphatase test 249. Cytochemical stains were performed on bone marrow smears from an acute leukemia patient, Gkiy All blasts were periodic acid-Schiff (PAS) negative. The majority of the blasts showed varying amounts of Sudan black B positivity, Some of the blasts stained positive for naphthol AS-D acetate esterase, some were positive for naphtitol AS-D chloroacetate esterase, and some blasts stained positive for both esterases. What type of leukemia is indicated? a lymphocytic b myelogenous ¢ myelomonocytic 4 erythroleukemia 250. Which of the following stains is closely associated with the lysosomal enzyme in primary (azurophilic) granules? @ peroxidase b Sudan black B © periodic acid-Schiff (PAS) 4 Prussian blue 251. What feature would not be expected in pseudo-Pelger-Huet cells? OStY a hyperclumped chromatin b decreased granulation © normal peroxidase activity normal neutrophils, Clinical Laboratory Certification Reaminations 1853: Hematology | Leukocytes: Laboratory Determinations Questions 252 Bxty 283 xb 254 Snes 255 tas ont 186 ‘30-year-old woman was admitted to the hospital for easy bruising and menorrhagia. Laboratory findings included the following: wee: 9.5 x 10%iL (3.5% 10%L) ABC: 2.48 10%/sL (2.48 x 10°2/L) Pits 30» 10%/L (80.0 x 10%/L) Hab: 86 g/l. (86 G/L} Het 25.0% cy: 400.7 pm? (100.7 fy cH 347 pg MCHC: 34.3% Pr: 34.0806 APTT: 62.5 sec TE 15.0500 FSP: 240 pg/ml (40 mg/L) fibrinogen: 315 mg/dl. 6.15 g/1) {control 200-400 ma/dt. [2.0-4.0 g/L Differential: Polys: 3% Lymphe: % Monos. 2% Myelos: 4% ‘Abnormal immature: 58% Blasts: 31% nRBC 1 Auer bodies, 1+ macrocytes, 1+ palychromasia The cells identified as “abnormal immature” were described as having lobulated nuclei with prominent nucleoli; the cytoplasm had intense azurophilic granulation over the nucleus, with some cells containing 1-20 Auer bodies, frequently grouped in bundles. A 15-17 chromosomal translocation was noted. Cells were SBB, peroxidase and NAS-D-chlovoacetate positive, PAS negative. Which of the following types of acute leukemia is most likely? a myeloblastic b promyelocytic € myelomonocytic d monocytic Which of the following leukemias is characterized by immature cells that are Sudan black B positive with discrete fine granules, peroxidase negative, PAS variable, strongly alpha naphthyl acetate esterase positive, and muramidase positive? acute lymphocytic chronic lymphocytic acute myelocytic acute myelomonocytic mae Chronic lymphocytic leukemia cells are most likely to express which of the following cell surface markers? a CD3, CD7, CD19 and CD20, b CD19, CD20, CD4 and CD5 © CD19, CD20, CD21, CDS d CD13, CD33, C107 Which of the following markers, typically detected in normal myeloid cells, are expressed on the surface of hairy cell leukemia lymphocytes? a CD3 b cba © CD11c 4 C103 ‘The Board of Certification Study Guide3: Hematology | Plarelers: Disease States Questions 277 aus 278 Ons 279 280 281 mas. onty 190 ADAMTS13 deficiency is responsible for thrombocytopenia found in: TTP DIC Hus ITP. ane Heparin induced thrombocytopenia (HIT) is an immune mediated complication associated with heparin therapy. Antibodies are produced against: a ACLA b PES © AT d B2GP1 In polycythemia vera, the platelet count is: aelevated b normal © decreased d variable Thrombocytosis would be indicated by a platelet count of a 100% 10°/p (100 «109/L) b 200x 103/pL (200 « 10°/L) © 300% 103/uL (300 x 109/L) 600 « 109/pL (600 « 10°/L) A 60-year-old man has a painful right knee and a slightly enlarged spleen. Hematology results indude hemoglobin: 16 g/dL (150 o/L) absolute neutrophil count: 10.0% 10%uL (10.0% 10°/L}, platelet count: 900 x 10%iL (900% 10°/L) uncorrected retic count: 1% normal red cell morphology and indices a slight increase in bands rare metamyelocyte and myelocyte giant and bizarre-shaped platelets This is most compatible with: congenital spherocytosis rheumatoid arthritis with reactive thrombocytosis, myelofibrosis idiopathic thrombocythemia moo ‘The Board of Certification Study Guide3: Hematology | Platelets: Laboratory Determinations Questions 282 283 284 Mts, ony 285) fas. Shty Which of the following is characteristic of platelet disorders? ‘a deep muscle hemorrhages b retroperitoneal hemorrhages ef mucous membrane hemorrhages d severely prolonged clotting times Which of the following is characteristic of Bemnard-Soulier syndrome? giant platelets normal bleeding time abnormal aggregation with ADP increased platelet count anes Which of the following is associated with Glanzmann thrombasthenia? normal bleeding time normal EPI aggregation abnormal initial wave ristocetin aggregation abnormal ADP aggregation Rowe ‘The preferred blood product for a bleeding patient with Type I von Willebrand disease is: a Factor Il, VII, IX, X concentrates b Platelet Concentrates ¢ Fresh Frozen Plasma ard Platelets ed- Cryoprecipitated ANE Platelets: Laboratory Determinations 286 287 288 A phase-platelet count is performed using a platelet Unopette™ (dilution = 1:100). 155 platelets ave counted on one side of the hemacytometer in the center square millimeter, and 145 are counted on the other side in the same area. After making the appropriate calculations, the next step would be to: repeat the procedure, using a 1.20 dilution with acetic acid report the calculated value collect a new specimen repeat the procedure, using a 1:200 dilution with saline ane ‘The chamber counting method of platelet enumeration: a. allows direct visualization of rhe particles being counted D hasa high degree of precision € has a high degree of reproducibility 4 is the method of choice for the performance of 50-60 counts per day Blood is diluted 1:200, and a platelet count is performed. 180 platelets were counted in the center square millimeter on one side of the hemacytometer and 186 on the other side. The total platelet count is: a 146 «105/uL (146 = 10°/L) b 183 10%/pL (183 x 10°/L) © 366« 103/uL (366 x 10°/L) 732 x 103/uL (732 x 10°/L) Clinical Laboratory Certification Examinations 191,3: Hematology | Platelets: Laboratory Determinations Questions 289 290 291 292 as ony 293 is ony 294 295 192 A phase-platelet count was performed and the total platelet count was 356 x 10°/pL (356 x 109/L). 10 fields on the stained blood smear were examined for platelets and the results per field were: 16, 18, 15, 20, 19, 17, 19, 18, 20, 16 The next step would be to: a report the phase-platelet count since it correlated well with the slide b repeat the phase-platelet count on a recollected specimen and check for clumping ¢ check ten additional fields on the blood smear repeat the platelet count using.a different method An automated platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should: a repeat the caunt on the same sample b report the automated count © perform a manual count 4 recollect in sodium citrate ‘The automated platelet count on an EDTA specimen is 58 x10"/pL, (58% 10°/L). The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils, The next step should be to’ report the automated platelet count since it is more accurate than a platelet estimate warm the EDTA tube and repeat the automated platelet count rerun the original specimen since the platelet count and blood smear estimate do not match recollect a specimen for a platelet count using a different anticoagulant ane Which one of the following is a true statement about megakaryocytes in a bone marrow aspirate? a an average of 1-3 should be found in each low power field (10x) b the majority of forms are the MK stage ¢ morphology must be determined {rom the biopsy section quantitative estimation is done using the 100% oil immersion lens Which of the following platelet responses is most likely associated with Glanzmann thrombasthenia? a decreased platelet aggregation to ristocetin b defective ADP release; normal response to ADP € decreased amount of ADP in platelets a. markedly decreased aggregation-to epinephrine, ADP and tallagen A bleeding time is used to evaluate the activity of: a platelets b prothrombin ¢ labile factor d Factor XIU ‘A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely te be abnormal in this patient? a platelet count b> template bleeding time prothrombin time activated partial thromboplastin time ‘The Board of ification Study Guide